Discussion of public health and health care policy, from a public health perspective. The U.S. spends more on medical services than any other country, but we get less for it. Major reasons include lack of universal access, unequal treatment, and underinvestment in public health and social welfare. We will critically examine the economics, politics and sociology of health and illness in the U.S. and the world.

Tuesday, May 24, 2005

Perverted Press Priorities

Would you like to know what the really big news is in Massachusetts right now? It was the lead story on every local TV news show last night, with multiple location shots and interviews. It was on the front page of the Boston Globule with a jump to almost a half page inside, featuring interviews with public health officials in two states, and multiple physicians.

Okay, here goes. Three people who received organ transplants from a single donor died from a virus, which the donor had contracted from a pet hamster. This virus (called lymphocytic choriomeningitis virus, LCMV, in case you're interested) is commonplace. It mostly infects rodents but humans can get it. It causes a mild, transient illness, or no symptoms at all. Transplant recipients take powerful immunosuppressive drugs, however, which is why these people died from what is ordinarily nothing more than a nuisance pathogen.

Now, I suppose there is some public interest in this story. It's slightly educational. But what does it mean to us?

Does it mean we should immediately get rid of our pet hamsters? No, there is no news here whatsoever about pet hamsters or any other kind of pet. This virus has always been around and it has always been a non-problem. It still is.

Does it in any way change our calculation about whether we should get an organ transplant? No, organ transplantation has always entailed a risk that some sort of pathogen will stow away on the grafts. This incident is not unique and provides no new information about the risk/benefit analysis of organ transplantation.

So why is this the biggest story in New England today? A couple of years ago West Nile Virus was discovered in the U.S. WNV also causes either no symptoms, or mild and transient symptoms in most people. Occasionally, people who are immunocompromised or extremely debilitated will have more severe illness or die from WNV. However, their risk of dying from influenza is thousands of times greater, and more generally, for people in that condition, if WNV doesn't get them something else will.

Yet for a period of more than three months, every time a human being, anywhere in the United States, was diagnosed with WNV, there was a news story about it in the Globe. The Boston Public Health Commission, responding to the public hysteria, drove trucks through the streets of my neighborhood spraying an organochlorine nerve toxin into the air, killing every insect from the ground to 30 feet or more above it, every garden snail and every frog, snake and toad in the park, just in case there were any infected mosquitoes around.

Should the average person worry about LCMV, or WNV? Absolutely not. You should be concerned about keeping your cutting board clean and your refrigerator cold, but cases of home-cooked food poisoning never make the front page of the Boston Globe or Fox News at 10. And as a citizen concerned about public health policy, you should be concerned about the bird flu and Medicaid, which we have not been reading about in the Globule or hearing about on the News at 10. But this incident, tragic as it is for 3 people and their significant others, is of essentially no public policy concern whatsoever.

Why are we given this distorted image of the world? I have my own thoughts, I'd love to hear yours.